Clinician Call to Action

The workforce survey also asked practices if they planned to hire now or in the next five years—and the response is another indicator that practice redesign is needed. The survey asked rheumatologists if they planned to hire now or in the future, a rheumatologist, a pediatric rheumatologist, a PA, or a nurse practitioner (NP). The results indicate a strong demand for rheumatology services.

click for large version

Who Is Hiring?

Change Your Practice

In the article “Pre-Appointment Management of New Patient Referrals in Rheumatology: A Key Strategy for Improving Health Care Delivery,” Dr. Harrington and Michael B. Walsh, DO, discuss implementation of a screening process for newly referred patients. This article, profiled in the workforce study report, outlines strategies that have been implemented by many ACR members to respond to the need for practice redesign. It listed three general strategies for improvement:

1. New patient screening;
2. Improved appointment scheduling; and
3. Improved quality of care for chronically ill patients.

Dr. Harrington and others have implemented a screening process for all new patients that follows an algorithm for determining if and when the patient should be seen by the rheumatologist, referred to another specialist or pain center, or referred back to the primary care physician. The rheumatologist reviews each case to make this determination. Some of the patients not seen by the rheumatologist were referred to an orthopedist or spine program. “Others were assured that their treatment through the primary care physician was appropriate,” the report notes. “The review of patient records prior to the first appointment had other benefits … it allowed the rheumatologists more information on the patient prior to the appointment so that they could decide whether a brief or longer visit was needed. Also, with the records on hand, duplicate testing occurred less frequently.”

Dr. Harrington tells The Rheumatologist that he was forced to look at redesigning his own practice when he lost the services of an orthopedic spine specialist and wait times in his practice went from two months to six months.

At that time, he and colleagues decided to take a deeper look at the 120 patients on his six-month waiting list and found that half had either gotten better or seen another physician during the six-month period. “As rheumatologists, we need to enforce clinical practice guidelines,” says Dr. Harrington. “We have to learn to do a better job of pre-appointment assessment and management. For instance, if we get a call from a patient with back pain for three days after lifting, the appropriate clinical assessment would send that patient to the primary care physician.”